Homestead_Brewer .ctl-c-p CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM 2n Slam Form 5473 burr 1-16)
Prasolbed by ow DepartmentalLood Government Fe mm HOW 1
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INS7RUC77ONS:See/evens side fording instructions
NOTE:telephone,Social Security,dials'cense,state ideredcabn and federal ideate:nn numbers are confderdal under 6-1.1-12-37.
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real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed out the date this application is signed, (date of signature). I(We):
119,Ovm. ❑ Am(are)bag order retarded mnuad.
Am(are) entitled to ticoupy as a tenant-slot holder of a cooperative housing oorporatiorh.
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❑ Have a beneficial interest in the trust a the right to oavpy the property under the terms of a qualified personal residence trust
❑ Am(are) the shareholder, partner,or member of the entity that alms the property.
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RmxdeYs cede whale Mixed b recorded
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} - PROPERTY�DESCRIPTIO4 i4e`r- r.-"- _ ...
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Gorey roseny O COUNTY AUDITOR
Pacer maxi legal dea0y`af PraPely its owedorr
,Red Prefer/ 0 Armnly=wad ratio tome(IC 61.1.7)
gee parboil d the residetd stremse Cr the laid nd eveedng one(1)Me that immediately stnwre is used b pros®name,desate Ne the at paten
d the Property lured b Proems beam
2 ' . 1S - 11 7303 —oco : 9 sir.—o21 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sae,Canty,at Tovedq lIS claimant vacating a homestead?
�1 ❑ Yes ❑ No
I hereby certify the above statements are true,coned,and complete X n
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Address el contact(waterer/sire*(oty,ate,,and ZIP t) /, of vacated(mesh,dcop d m� eneat 0iy,sab.and Zinc.*
qr. s S0OFr' •i vil c " i'}-6 6, .
ASSESS•O•R USE ONLY-: ' I ASSESSED VALUE.-- I ;Wolf ESTEADIALDE'_.,Ie? lON-RESIVENTIAG'-:
Land not exceeding one(()acre Immediately 4 4 iW '£ y4-) -
sunoundarg residential improvements (1) - -. -FcC ; a0-
Other land (2) ..Ac-h5+c,e•.,-::.T`'
Total land(line I plus Gne 2) (3)
Residential improvements or Dwelling (4) - 2 :_S 3'
annua ly assessed mobile I a
nu mafmdrnnd home Garage (5) r*IE . .._
r i
Other improvements (6) s €1-k-:K ,1; ,ri
Total improvements pine 4 through line 6) CO
Total value(Una 3 pits lure 7) (8)
I hereby certify the above is true,correct, �' °dPsmerar Date raced(canal tax)era)
and complete.
Verifying advn-Sipraoe aMuawr Dam sped(month day,lea)
20_pay 20 Lesser of 60%of the assessed vffire of the homestead or$45,000.
Notwmhsta - , other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
that is not a--• real properly or to a manufactured home that is not assessed as real properlymay Waive Dale a71na not exceed•
� ;assessed yaflm mobile horro ornnamWarduadlome. p7rr
tmatrTIDN:Oittral--CanyAuidar, apeya
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